Adequate levels of vitamins and minerals are crucial to an individual’s proper growth and development, as well as maintenance of good oral health. When a person has a deficiency of one or more of these substances, symptoms may affect various areas of the body, including the mouth and teeth.

Vitamins are organic substances (which contain carbon and hydrogen) that help maintain the body’s normal metabolic functions. Minerals are inorganic substances (which do not contain carbon and hydrogen) that are also essential to metabolic functions and nutrition. For the most part, these substances come from sources outside the body -- mainly the diet.

People have individual needs for vitamins and minerals based on their age, gender, physical health, daily activity regimen, and whether or not they are pregnant or breastfeeding. Most people who do not have illnesses or other special conditions can get the required amount of vitamins and minerals simply by eating a well-balanced diet. However, numerous studies have shown that most people do not get the recommended amount of these substances. The exact effect of the widespread, slight deficiency in vitamins and minerals is unknown, but many nutritionists recommend at least basic supplementation to bring intake of vitamins and minerals in line with United States Department of Agriculture (USDA) recommendations.

Severe vitamin deficiencies can have acute effects. Patients may experience a burning sensation of the tongue and mouth. Patients may have swallowing difficulties and the tongue may feel like it is swollen and appear pale. Some deficiencies of the B vitamins may cause paleness and weakness of the tissue in the inner cheek, or excessive salivation. Mineral deficiencies can cause similar problems, and may contribute to improper development of the teeth or the bones of the mouth.

Vitamins play a vital role in maintaining good oral health. Adequate levels of these substances are crucial to proper growth and development, as well as maintenance of good health. When a person has a deficiency of one or more vitamins, symptoms may affect various areas of the body, including the mouth and teeth. Additionally, poor oral health often affects eating habits, with the affected person eating less fresh fruits and vegetables. This may exacerbate vitamin and mineral deficiencies with wide-ranging affects.

Vitamins are organic compounds that help maintain the body’s normal metabolic functions. They come from sources outside the body — chiefly from the diet. There are two major types of vitamins:

• Fat-soluble vitamins. These vitamins are absorbed in the gastrointestinal tract and stored in the liver and body fat. The body’s ability to store these vitamins means that deficiencies may not be evident for some period of time. Examples of fat-soluble vitamins include vitamins A, D, K and E.
  
  
• Water-soluble vitamins. These vitamins are absorbed in the gastrointestinal tract and distributed throughout the body. They are not well-stored in the body, so deficiencies usually become evident very quickly. Examples of water-soluble vitamins include vitamin C and B-complex vitamins.

People need varying amounts of vitamins based on their age, gender, physical health, daily activity regimen, and whether or not they are pregnant or breastfeeding. The U.S. government has established guidelines for the recommended dietary allowances of vitamins and minerals for healthy individuals. These are primarily based on a person’s age and gender.

Whole foods (foods that are not processed or refined) are the best sources of vitamins. Vitamins from foods are the most easily absorbed by the body and they also include small amounts of other nutrients that supplements do not contain. Most people who do not have illnesses or other special conditions can get the proper amount of vitamins they require simply by eating a well-balanced diet. However, many studies have shown that the majority of Americans' diets do not supply the recommended levels of vitamins and nutrients, especially those that are present in fruits and vegetables. For this reason, many nutritionists recommend supplementing with a quality, wide-spectrum multivitamin.

When people do not get the proper amount of vitamins, they develop vitamin deficiencies. This can occur for several reasons. A poorly balanced diet can cause vitamin deficiencies. Also, as people get older, they do not absorb vitamins as readily, which can lead to deficiencies. Other causes include chronic diseases or medications that interfere with the body’s ability to absorb vitamins.

Poor oral health can be both a cause and effect of vitamin deficiency. This can occur for several reasons. The most common cause is a poorly balanced diet. Groups most commonly affected by vitamin deficiency include the elderly, vegans (who avoid animal products), the very poor, alcoholics, and patients who have undergone obesity surgery such as gastric bypass.

The elderly, especially, suffer from vitamin and mineral deficiency. Tooth loss can influence the ability to chew certain types of foods and limit vitamin intake. Coupled with loss of interest in food, the result can be malnutrition. The problem is worsened because absorption of vitamins and minerals can be severely impaired among older people. For example, vitamin D absorption is dramatically reduced among the elderly, which in turn affects calcium utilization, which then affects bone and tooth health.

A dentist, hygienist, or other dental health professional who recognizes signs of vitamin deficiency – such as an abnormality in the mouth tissue or delayed tooth development – will likely refer the patient to a physician for proper treatment.

Several types of vitamin deficiencies can affect oral health. Inadequate levels of vitamin B are among the most common deficiencies related to oral health problems. Such deficiencies typically cause a burning sensation of the tongue and mouth. Patients may have swallowing difficulties and the tongue may feel like it is swollen. Deficiencies of some B vitamins may cause paleness and weakness of the tissue in the inner cheek and tongue. Tissue may break apart easily or slough off. Other oral symptoms associated with vitamin B deficiencies include mouth lesions, loss of taste, excessive salivation and enlarged salivary glands.

Patients with deficiencies of B vitamins may experience a plunge in their level of red blood cells, causing anemia. In addition, low levels of specific types of B vitamins may cause their own symptoms. People who are deficient in vitamin B12 (cobalamin) may experience gastrointestinal symptoms and numb or tingling limbs. People with low levels of vitamin B9 (folic acid) may also experience numb or tingling limbs in addition to a burning sensation in the mouth. Some researchers believe that reduced amounts of certain B vitamins may increase the risk of oral cancers. Other oral health problems attributed to B vitamin deficiencies include:

• Angular cheilitis. Inflammation and cracking of the corners of the mouth typically due to a fungal infection. It is often associated with deficiency of riboflavin (vitamin B2) or folic acid.
  
  
• Atrophic glossitis. Condition in which the taste buds on the tongue begin to deteriorate, affecting the sense of taste. This symptom is often associated with a lack of folic acid.
  
  
• Chronic oral mucosal candidiasis. Fungal infection of the mouth. This fungus is normally present in the mouth but can develop into an infection when a person has B vitamin deficiencies.
  
  
• Recurrent aphthous stomatitis. These are recurring canker sores caused by anemia. This symptom is often associated with a lack of niacin (vitamin B3).

Vitamin C is essential to the maintenance and repair of the tissue collagen. A vitamin C deficiency most often occurs as the result of eating inadequate amounts of fresh fruit and vegetables and is more likely to occur in winter, when such foods may be less abundant. Vitamin C deficiency was formerly known as scurvy and was common in people deprived of fresh fruits and vegetables, such as sailors. People who smoke are at a greater risk of developing vitamin C deficiency because smoking decreases the level of vitamin C in the body.

Deficiency of vitamin C may cause gums to bleed easily. Other symptoms include fatigue and tendency to bruise readily all over the body. A dentist can help determine if the patient has low levels of vitamin C or has an oral condition like gingivitis, which also causes the gums to bleed easily.

Vitamin A contributes to skin cell growth and repair and is involved in the formation of tooth enamel. Diseases that can cause this deficiency include cystic fibrosis, cholestasis (liver/bile duct problems), pancreatic insufficiency and chronic diarrhea.

Deficiency of vitamin A can lead to delayed healing of sores in the mouth, incomplete tooth development or cavities in young children. Because of the liver's ability to store vitamin A, it may take up to a year before the signs of deficiency are apparent in some patients. Excessive levels of vitamin A can lead to oral health problems such as gingivitis and fissures (tears) of the oral mucosa.

Vitamin D plays a key role in the regulation of calcium and phosphate metabolism. It is essential to the formation of strong bones and teeth. Patients on low-fat diets and those with malabsorption syndromes are at higher risk for this deficiency. Others who may be at risk include people who eat a vegan diet, which prohibits foods from animal origin, and people taking anticonvulsant or sedative-hypnotic drugs.

Deficiency of vitamin D can lead to weakening and brittleness of the bones. In the mouth, this may cause a jaw fracture or periodontal disease. When it occurs in young children, it can negatively impact tooth formation.

People with vitamin deficiencies may adjust their diets or take a supplement that provides the vitamins they lack. While these supplements provide some nutrients, they cannot replace all of the benefit associated with eating certain foods.  Patients who take supplements should inform their dentist if they are also taking drugs such as anticoagulants or iron supplements, because too much of some vitamins can interfere with how these drugs work.

Diets rich in certain foods also will boost the levels of these vitamins. People with low levels of B vitamins  should eat different types of foods depending on the nature of the deficiency. Source of the various B vitamins include the following:

• Thiamin (B1). Liver, legumes, nuts, pork, whole and enriched grains
  
  
• Riboflavin (B2). Broccoli, eggs, meat, milk and milk products, whole and enriched grains
  
  
• Niacin (B3). Eggs, fish, meat, milk, nuts, poultry, whole and enriched grains
  
  
• Pyroxidine (B6). Bananas, enriched grains, fish, leafy green vegetables, legumes, meat, poultry
  
  
• Folic acid (B9). Asparagus, broccoli, fortified cereals, leafy green vegetables, legumes, oranges
  
  
• Cobalamin (B12). Eggs, fish, fortified cereals, meat, milk and milk products, poultry

Most other vitamins also can be obtained through dietary sources, although the body can manufacture vitamin D on its own as long as a person is exposed to at least several minutes of sunlight two to three times a week. The amount of sun exposure needed to produce enough vitamin D depends on skin tone. People with darker skin require longer sun exposure than people with lighter skin.

Most other vitamins can be obtained through dietary sources, or from the body itself which can manufacture vitamin D after exposure to sunlight. In recent years, researchers have uncovered widespread vitamin D deficiencies, especially among people who live at higher latitudes and among darker-skinned people. Current recommendations from the Institute of Medicine suggest that everyone receive at minimum of 200 IU daily of vitamin D, which can easily be obtained by about 15 minutes of direct sun exposure daily. However, because of absorption problems among elderly, some researchers believe a higher level, such as 800 IU daily coupled with adequate calcium, is recommended to prevent fractures. The Institute of Medicine has found that the tolerable upper level intake of vitamin D is 2,000 IU daily.

Some dietary sources of these vitamins include:

Deficiencies of certain minerals also can have an impact on a person’s oral health. Minerals are inorganic elements. Like vitamins, minerals are essential to proper growth and development. Essential minerals for good health include calcium, chromium, copper, fluorine, iodine, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, sodium and zinc. In particular, lack of the minerals iron and calcium can have significant impact on a person’s oral health.

Iron is essential in the transportation and uptake of oxygen and carbon dioxide in body tissues. It also plays a major role in metabolizing dietary protein. Low levels of iron cause oral health symptoms similar to those of B vitamin deficiencies (e.g., sore mouth). Poor diet, intestinal problems and blood loss (e.g., heavy menstruation, internal bleeding) can result in these deficiencies.

Calcium is essential to the development of strong teeth and bones. Calcium deficiencies sometimes occur because of poor calcium content in a person’s diet. Vegans (people who avoid eating any animal products) are particularly susceptible to this condition unless they get calcium from another source. Additionally, low vitamin D levels affect calcium absorption and utilization.

Dietary sources of these minerals are as follows:

Preparing questions in advance can help patients have more meaningful discussions regarding their conditions. Patients may wish to ask their doctor the following questions related to vitamins and oral health:

1. How will I know if I am getting adequate levels of vitamins and minerals?
   
   
2. Should I consult with a dietician or another resource in planning a well-balanced diet?
   
   
3. What symptoms should I look for that might indicate a vitamin or mineral deficiency?
   
   
4. How will you diagnose my vitamin or mineral deficiency?
   
   
5. Could my symptoms be the result of another condition?
   
   
6. What are my treatment options?
   
   
7. Will taking a multivitamin adequately treat my deficiency?
   
   
8. How long will it take before my oral symptoms clear?
   
   
9. Am I at risk for any long-term oral health problems because of my history of deficiency?
   
   
10. How much time do I need to spend in the sun to ensure proper levels of vitamin D?